Provider Demographics
NPI:1972599587
Name:DODD, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:DODD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AVENUE F NE STE 9118
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4131
Mailing Address - Country:US
Mailing Address - Phone:863-292-4004
Mailing Address - Fax:863-292-4005
Practice Address - Street 1:200 AVENUE F NE STE 9118
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4131
Practice Address - Country:US
Practice Address - Phone:863-297-1777
Practice Address - Fax:863-297-1756
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0504742086S0129X
FLME96463208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56676OtherBCBS
FL276165300Medicaid
FL56676OtherBCBS
FLD93179Medicare UPIN
FLAB087VMedicare PIN
FL276165300Medicaid
FLAB087ZMedicare PIN
FLP00378043Medicare PIN
FLAB087NMedicare PIN
FLAB087WMedicare PIN
FLP01747841Medicare PIN
FLAB087XMedicare PIN